Default 90-day statin prescriptions reduced racial, income disparities in practice, trial finds
Setting 90 days as the default length for all statin prescriptions in the EHR eliminated disparities in which patients who were non-Hispanic Black, on Medicaid, or living in ZIP codes with a median household income lower than $50,000 were less likely to receive 90-day prescriptions.
Increasing the default duration of statin prescriptions in the electronic health record (EHR) reduced racial and socioeconomic disparities in prescription length, a study found.
To examine how changing the default setting affected clinician prescribing behavior, researchers set 90 days as the default length for all statin prescriptions in the primary care EHR of a large academic health system in November 2022. The results were compared to prescriptions for levothyroxine, because it is commonly prescribed and did not undergo the same change in default prescription length. Results were stratified by race and ethnicity, insurance, and household income and were published April 7 by JAMA Internal Medicine.
There were 5,698 statin prescriptions written in the study period prior to the default change (from July to November 2022) and 18,530 prescriptions written from November 2022 to January 2024. The proportion of prescriptions written for a 90-day supply increased from 70.7% to 91.7% following the intervention, an adjusted increase of 20.3 percentage points (95% CI, 18.3 to 22.2 percentage points; P<0.001).
Before the 90-day prescription became the default, Hispanic and non-Hispanic Black patients, Medicaid beneficiaries, and those living in ZIP codes with a median household income lower than $50,000 were less likely to receive 90-day prescriptions. After the default change, all subgroups were equally likely to receive 90-day prescriptions except for Hispanic patients; the gap between Hispanic and non-Hispanic White patients was reduced from 19.9 to 6.9 percentage points. There was no difference in the proportion of patients who had a change in type or strength of statin prescription (2.8% vs. 2.6%; P=0.25).
The study authors wrote that a simple restructuring of choice architecture in the EHR may increase the adoption of evidence-based strategies for improving adherence, without restricting patient or physician choice.
“Regardless of cause, the elimination of disparities after the change in default prescription length highlights how well-designed default changes can reduce health disparities,” they wrote. “Moreover, 8% of patient-clinician dyads actively choosing a 30-day supply, presumably for relevant clinical or patient-preference reasons, highlights the freedom of choice preserved by this intervention structure.”
An editorial stated that nudging prescribers toward 90-day refills may itself be beneficial simply by reducing the patient's health care burden, including time spent tracking remaining pills, contacting the physician's office or pharmacy, and picking up the medications. There may also be a decrease in burden on physicians and office staff.
“Over the past several decades, there has been an increased interest in making clinical care more patient centered and less burdensome,” the editorial stated. “Yet, too many care delivery models and processes still unnecessarily consume patients' time and energy. Approaches like changing the default prescription length can be readily incorporated with minimal immediate impact on the clinician's time while also improving equitable provision of medical care.”